title: Evaluation of home telehealth following hospitalization for heart failure: a randomized trial.
abstract: Previous studies have found that home-based intervention programs reduce readmission rates for patients with heart failure. Only one previous trial has compared telephone and videophone to traditional care to deliver a home-based heart failure intervention program. The objective of this study was to evaluate the efficacy of a telehealth-facilitated postdischarge support program in reducing resource use in patients with heart failure. Patients at a Midwestern Department of Veterans Affairs Medical Center were randomized to telephone, videophone, or usual care for follow-up care after hospitalization for heart failure exacerbation. Outcome measures included readmission rates; time to first readmission; urgent care clinic visits; survival; and quality of life. The intervention resulted in a significantly longer time to readmission but had no effect on readmission rates or mortality. There were no differences in hospital days or urgent care clinic use. All subjects reported higher disease-specific quality of life scores at 1 year. There was evidence of the value of telephone follow-up, but there was no evidence to support the benefit of videophone care over telephone care. Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective.
authors.affiliation: Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201, USA. bonnie.wakefield@va.gov
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Wakefield
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.forename: John E
authors.initials: JE
authors.lastname: Holman
authors.forename: Annette
authors.initials: A
authors.lastname: Ray
authors.forename: Melody
authors.initials: M
authors.lastname: Scherubel
authors.forename: Trudy L
authors.initials: TL
authors.lastname: Burns
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kienzle
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D040421:Cell Phone; D003266:Continuity of Patient Care; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006787:Hospitals, Veterans; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011336:Probability; D016016:Proportional Hazards Models; D011788:Quality of Life; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D013690:Television; D014741:Video Recording